The Most Fundamental Problem

[Guest guest]

Over the years, I've had to balance the issues of patient refusals and

professional EMS service. I too have the upbringing and training that says as

Paramedics we evaluate, we treat, and we transport - that every call is a call

for service and opportunity to care for people. But having been associated with

an EMS that makes approximately 120,000 calls per year I've had to soften a bit

to the realities of delivering EMS to an urban area.

There are limited ambulances, limited funds for personnel, and increasing calls

for service. If this EMS transported even 70% of the calls received, the ER's

would riot against the medics transporting, the services' administrators and

medical director. Not to mention the reduction of ambulances available for other

calls that delay response times and make citizens and city council members

angry.

I balance that reality with what I know from our QA and PI programs. In almost

every instance of a patient or family member complaint, hospital complaint,

protocol error, or detrimental patient outcome, it is due to a patient NOT being

transported. One of the biggest responsibilities medics have is making the

decision to NOT transport a patient, and as our curriculum stands now we do not

have the level of training we need to do this or the level of accountability to

understand the consequences. Neither do we have the level of reimbursement to

makes those 2 issues change significantly. Despite the seriousness of this

decision, it is the decision to not transport a patient over 50% of the time an

ambulance is called.

In San , BLS units were used to transport patients that didn't require

ALS after an ALS unit responded and evaluated the patient. It was determined

that this was not a adequate method to increase available units and the project

was terminated after several months. A taxicab voucher program has been used for

several years successfully here to transport " patients " who have no medical

emergency or very minor issues where an ambulance is not required for transport.

This is a one-way trip to the hospital that is allowed only after online medical

control consultation from the scene and occurs only a few times a day so it is

not abused by medics or callers.

Lance

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Lance Villers, PhD, LP

Asst Professor & Chair,

Department of Emergency Health Sciences

University of Texas Health Science Center at San

7703 Floyd Curl Dr, MC 7775,

San , TX, 78229-3900